App Helps Diagnose Gout Using Evidence-Based Medicine

Has potential to change practice, says Douglas Maurer, DO, MPH

How do you make the proper diagnosis of gout? The "gold standard" is joint aspiration with evaluation under polarized microscopy. This process is painful for the patient, challenging to complete in a 20-minute appointment, and frequently the aspiration is unsuccessful. Many patients are treated empirically, which can lead to under/over diagnosis, improper treatment, and exposure to dangerous side effects from gout medications.

What if there was a better way that could completely rule out or rule in the diagnosis in some patients without aspiration, leaving only a small proportion who require the painful and tedious aspiration procedure? In 2010, Dutch researchers doctors Janssens, Fransen, and colleagues did just that through their derivation and validation of a diagnostic rule for making a proper gout diagnosis. The issue is that none of the most popular medical calculators such as MDCalc, QxCalculate, or MediMath include this rule!

Dr. Joshua Steinberg comes to the rescue again! He contacted the study authors and was given their permission to develop the diagnostic rule into a free medical app. For years, I have used Dr. Steinberg's many outstanding free medical apps. This past year alone he has released many medical apps that I have reviewed on iMedicalApps, including PneumoVaccines, Depo Calendar, and OB Wheels in addition to his newest app, Gout Diagnosis. Other useful point-of-care apps by Dr. Steinberg include PreopEval14, PFT Eval, EFM Guide, PE & DVT Dx Tool, and my favorite, Pneumonia Guide.

The content of the Gout Diagnosis app consists of a main screen with five different languages to choose from, with smaller icons along the bottom for references, disclaimers, etc. Once you choose the language from the main screen, you are taken to the main calculator screen which asks a series of seven "Yes/No" questions and outputs a score. The score ranges from 0 to 13 points and corresponds to a "very unlikely, indeterminate, or very likely" risk of having gout. Additionally, Dr. Steinberg includes links to the references for the medical app and a detailed discussion on the evidence behind the calculator.

Likes:

Fantastic evidence-based calculator that will change practice.

Well-referenced with hyperlinks to PubMed.

Available in five languages.

Dislikes:

Use of calculator output data could be more intuitive with better statistical descriptions.

Medical app does not contain information on treatment of gout.

Not available for Android.

Overall:

This is another simple but outstanding addition to Dr. Steinberg's growing collection of free point-of-care medical apps. The Gout Diagnosis app has the potential to genuinely change practices in primary care (and even rheumatology clinics), by applying this valid but not well-known algorithm to ensure a proper diagnosis of gout is made at the point of care.

This post appeared oniMedicalApps.com. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. government.

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